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New Challenges During Pregnancy That Can Interfere with Being Active

Diabetes
Having gestational diabetes (diabetes in pregnancy), does not prohibit exercise. With your doctor's guidance, exercise at low and moderate levels is recommended to maintain blood sugars and insulin balance. You should have two doctors monitoring you, your obstetrician and your diabetes doctor (usually your internist, endocrinologist, or diabetologist). Blood sugars should be closely monitored when first starting the exercise, and you should have a snack available at all times. If you have diabetes, exercise sessions should not last more than 30 minutes unless you check and maintain normal blood sugars. Scheduling an appointment with a nutritionist who is a certified diabetes educator (CDE) is recommended to assist with evaluating and meeting your nutritional needs. This service is usually covered by health insurance. Drinking plenty of fluids is also especially important in diabetes and pregnancy.

Numbness
Numbness is a symptom that can occur in different areas of the body, including wrists and hands, feet, and occasionally the stomach and thighs. Patterns of numbness follow the path of nerves. Carpal tunnel syndrome, one of the most common causes of numbness, is hand and finger numbness, tingling, and pain. It is not known exactly why this occurs during pregnancy, but fluid retention is thought to contribute. To make sure these symptoms do not worsen, see a specialist if you have numbness with pain or problems lasting longer than one week. Wearing a wrist splint at night and during daily activities might be all you need to solve the problem. Carpal tunnel syndrome of pregnancy also responds to icing, stretching, and occupational therapy if the symptoms are severe. Additional vitamin B6 can also help (ask your doctor before taking this). Carpal tunnel syndrome usually resolves a few months after pregnancy, although it can sometimes be made worse with child-care activities.

Leg Cramping
Leg cramping at night can be a common irritant during pregnancy. As long as the cramping goes away and is not accompanied by severe back pain or cramping elsewhere, leg cramps are not a sign of anything serious. Stretching or getting up and walking around usually relieves them. Stretching your legs before bed also can help. Sometimes, cramping is a sign that you are not eating enough salt, potassium, or calcium (see chapter 13, "Exercise Problems and Injuries"). Sports drinks are a good source of potassium and salt. You can also try taking an extra dose of calcium at bedtime.

Sore Breasts/Nipples/Belly Button
Tender and swollen breasts can occur early in pregnancy and cause discomfort during exercise and activities. Make sure you wear a supportive, well-fitting athletic bra to prevent irritation. As the pregnancy progresses, soreness of the belly button can also occur and cause discomfort when it rubs against your clothes during activities. Applying a large Band-Aid to belly button can help. If you are nursing, wear your supportive maternity bra and use lanolin on your nipples to ease the dryness.

Varicose Veins/Leg Swelling
Varicose veins can be common in pregnancy, although regular exercise makes them less likely. They can cause both lower leg and thigh tightness and pain, especially when standing. If varicose veins and swelling are a problem, consider taking up swimming (with a flutter kick). Moving your feet up and down and in circles throughout the day and elevating them as much as possible is also helpful. Support stockings not only help with symptoms but also prevent worsening of the varicosities. Under no circumstances should you take diuretics!

Poor Sleep
During the first and third trimester, pregnancy is infamous for interfering with sleep. Factors include breast and abdominal discomfort, leg cramps, baby's movements and having to go to the bathroom frequently during the night. This, along with the fatigue that is present in general, can lead to a stressed, emotional, exhausted expectant mother. Do not try to exercise on the days you have not slept well. You might also notice increased nausea on those days. Try to take naps if you can, and go to bed earlier at night.

Back and Pelvic Pain in Pregnancy and Exercise
Back and pelvic pain in pregnancy is very common and can be a significant concern in athletic pregnant women. Most pregnant women experience some type of back or pelvic ache or pain at some point in their pregnancy. Occasionally, pregnancy-related back or pelvic pain can continue beyond pregnancy; therefore, it is best to do the most you can to prevent it from becoming severe. Fortunately, as an active, strong woman, you are at less risk of serious back pain.

There are many types of back pain in pregnancy. Most is felt low in the middle back and pelvis, although it can be one sided or in the middle back. Some only get pain in the evening or at night. Back and pelvic pain is related to hormones, biomechanics, circulation, posture, and activity level.

Pregnancy hormones have multiple roles in the cause of back pain. They cause water retention in the tissues and ligaments, putting pressure on not just these structures but the joints as well. Also, the hormone unique to pregnancy, relaxin, leads to the pelvic loosening that is needed for childbirth. This hormone and the increased movement in the pelvis that occurs can cause pain at the sacroiliac joint and in other ligaments of the spine. Occasionally, the abdominal muscles can split (diastasis recti), compromising spine and abdominal stability. Stability problems in the back and abdomen can lead to increased risk of back pain. Strengthening surrounding and supporting muscles before and throughout pregnancy protects these looser structures and can prevent pain related to changes in stability.

Relaxin, the Hormone of Pregnancy

Posture is a factor of back pain that can be modified. Maintaining good posture reduces the increased arch in the lower back that is so common to pregnancy. Muscles can get fatigued trying to hold certain positions, causing increased pain at the end of the day. Toward the end of pregnancy, you might walk a little differently or get out of a chair by leaning farther forward or twisting. Strengthening exercises to keep the spine and abdominal muscles strong will prevent body positions that cause more problems. Keeping your legs and core as strong as possible will prevent compromising movement patterns.

Symptoms of Back or Pelvic Pain Due to Ligament Looseness at the Pelvis

Diffuse middle and lower back pain is usually due to muscle spasms, strain, and fatigue. This dull and achy pain can be made worse bending, lifting, and sitting or standing for a long time. Sometimes, it can be sharp with sudden movements, and it is often worse at the end of the day. Weakness of the core stabilizing muscles, including the abdominal muscles, contributes to this discomfort. Middle and lower back pain of this nature usually is relieved with massage and stretching.

Symptoms of Back Pain Due to Muscle Strain

How to Prevent Back Pain in Pregnancy Less frequent types of back pain during pregnancy include sciatica, night pain, and bone pain. Sciatica, or leg pain related to back pain, can occur but is very rare. If you are having leg pain, weakness, or numbness in the legs or pelvis, see your doctor as soon as possible. Back pain at night is often attributed to sleeping position and can also result from day-long fatigue and gravity-related biomechanical stress. Sleeping on your left side is more comfortable and also ensures the best blood flow to both you and your baby. Osteoporosis can sometimes be a cause of back and pelvic pain in pregnancy, and although rare, is another reason for taking calcium supplements and vitamin D and making sure you have a healthy diet with enough protein, fat, and calories.

Severe, continuous back pain can be a sign of fetal distress. If back pain is associated with fever, bleeding, severe cramping, or fluid leaks, call your doctor at once. Other internal causes that can lead to back pain include urinary tract infections; stomach or digestive disorders, including constipation; lung or heart problems; or other organ problems. Having pain that is persistent and not relieved by changing position, activity, or rest needs to be evaluated by your doctor. Neurologic symptoms including numbness, weakness, and loss of reflexes require close medical supervision. Do not exercise if you are experiencing any of these dangerous symptoms.

WARNING Call your doctor immediately if you have severe back pain, bleeding, severe cramping, or fluid leaks.

Most back pain can be relieved with modifications in posture, positioning, and activity schedule. Avoid bending, lifting, and twisting without bending your knees and stabilizing your spine (suck in your lower belly with these movements). Avoid activities that make the discomfort worse (such as jogging). Do not wear high heels, and preferably wear walking shoes with extra cushioning. Be aware of sitting, sleeping, and activity positions and posture, and use lumbar cushions and pillows as needed. Using a wedge-shape pillow to support you abdomen while lying on your side can be helpful to relieve back and pelvic pressure. Relaxation techniques and 10 minutes of ice or heat packs to the painful area (not over the front of the abdomen or pelvis) can be helpful. Exercising or swimming in a pool can be very effective to prevent and treat back pain. An SI brace can be helpful with back and pelvic pain due to ligament looseness; a more supportive maternity brace can be worn for general back pain due to postural and muscle strain. The supportive "mother to be" brace may also be worn while exercising to prevent jostling.

More aggressive, active treatment for back pain in pregnancy includes physical therapy, which is recommended for back pain that persists for more than a few weeks, seems to be worsening, or interferes with sleep or activities. Accepted alternative therapies include acupuncture, acupressure, and gentle manipulations. Do not use whirlpools, saunas, or heat over the abdomen and pelvis. The safest medication to take for pain relief is Tylenol; do not take any other medications, even those without a prescription, unless you ask your doctor first.

Management of Back Pain in Pregnancy

If back pain continues after pregnancy, more aggressive treatments can be helpful and curative. See a sports medicine or back doctor (orthopedist or physiatrist) as soon as possible to prevent the pain from becoming chronic. You might need x-rays or an MRI to evaluate the cause. If you are breastfeeding, check with your pregnancy-care physician or pediatrician before taking medications for pain.

Exercise Equipment and Clothing
To accommodate for temperature changes during exercise, you should wear layers of loose, breathable clothing. The newer synthetic materials are excellent to exercise in as they "breathe," preventing heat from getting trapped inside the clothes. Be aware that wearing a hat keeps heat in. Switch to a visor to keep the sun out of your face but let your heat out.

As your breasts increase in size, you will need more support. Most athletic stores have a range of sizes of supportive athletic bras; you can also order from the manufacturers.

Your shoes should be well cushioned and supportive. You might need a half or full size larger to accommodate to fluid retention. Too tight shoes can cause unnecessary numbness, tingling, and pain. Be careful not to have shoes that are too big, however, as shoes that are loose can cause you to trip and fall. Getting a few bigger-size pairs of shoes in pregnancy is a very worthwhile investment. If you have trouble finding wider sizes, consider looking in the men's or boy's department, as their shoes are wider throughout.

Special Situations in the Third Trimester
WARNING: Lying on your back for more than five minutes in the third trimester can compromise blood flow to the baby.

During the third trimester, your body size is growing to its maximum. Due to your expanding size, you might find engaging in high-impact activities or brisk walking uncomfortable. It can be more difficult to get around as quickly as you did before, so slow down! You should eliminate any activities in which you might fall or where quick stops and starts are needed such as in tennis or field sports. Balance is challenged by your new size, looser ligaments, and loss of sight of your feet. Your added weight can further stress your joints in your feet, ankles, knees, hips, and, of course, back.

Organs can become crowded by the size of your baby. Because the space for your lungs is compromised, you might feel more easily short of breath. Your bladder cannot hold as much urine as before, and pressure from the expanded uterus might cause you to urinate more frequently. You might have trouble holding in your urine with coughing or if your bladder gets too full. Do not let this stop you from drinking enough fluids. Even if you have to go to the bathroom every 30 minutes or wear mini pads, keep drinking.

Sleeping can become a challenge due to difficulty getting comfortable and frequent urination. Let yourself take naps, and remember that rest is essential to your and your baby's health. Try to lie on your left side as much as possible; not on your back. If you are too tired to exercise due to a bad night's sleep, rest.

Braxton-Hicks contractions are mini-contractions that help reposition the baby, but if they become frequent, they are a sign that you need to rest. If you get them while being active, stop and rest. Drink an extra glass of water, and if they do not stop, lie on your left side. If they last longer than 30 minutes or are closer than 10 minutes apart, call your doctor.

From The Active Woman's Health and Fitness Handbook by Nadya Swedan. Copyright © 2003 by Nadya Swedan. Used by arrangement with Perigee, a member of Penguin Group (USA) Inc.

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